MBA5520 Case Study 2 - To practice identifying management

MBA5520 Case Study 2

Exercise 8.1Objectives:•

To practice identifying management behaviors that demonstrate collaborative teamwork and continuous improvement.• To explore how collaborative teamwork and continuous improvement influence the patient experience.

Instructions:•

Read the case study, which is drawn from The New Pioneers: The Men and Women Who Are Transforming the Workplace and Marketplace(1999) by former Wall Street Journal columnist Thomas Petzinger Jr. •

1.Describe several examples of how management demonstrated the principle of continuous improvement in the case study.•

2.Describe several examples of how management demonstrated the principle of teamwork in the case study. Applying Quality Management in Healthcare: A Systems Approach138•

3.Describe how your responses to the two previous instructions contributed to the quality of the patient’s experience (service quality) and the quality of the clinical service (content quality). MLA (Modern Language Assoc.) Spath, Patrice, and Diane L. Kelly. Applying Quality Management in Healthcare?: A Systems Approach. Vol. Fourth edition, Health Administration Press, 2017. APA (American Psychological Assoc.) Spath, P., & Kelly, D. L. (2017). Applying Quality Management in Healthcare?: A Systems Approach: Vol. Fourth edition. Health Administration Press.

Applying Quality Management in Healthcare: A Systems Approach140backsides exposed to the world. Partly this reflected a medical culture that considered the procedure, not the patient, as the customer. As the administrator put it to me, “If you’re naked on a stretcher on your back, you’re pretty subservient.” Family members, meanwhile, had to roam the hospital in search of change so they could coax a cup of coffee from a vending machine. She marveled at the arrogance of it. “You’re spending $3,000 on a loved one, but you’d better bring correct change.”Fortunately, this administrator had the political standing to push through big changes, and although the staff surgeons effectively had veto power, most were too busy to get deeply involved in the improvement process. Because few patients enjoy getting stuck with needles, the nurses created a process for capturing the blood from the insertion of each patient’s intravenous needle and sending it to the lab for whatever tests were necessary. This cut down not only on discomfort, but on time, money, and scheduling complexity. The unremitting bureaucratic questions and paperwork were all replaced with a single registration packet that patients picked up in their doctors’ offices and completed days before ever setting foot in the hospital; last-minute administrative details were attended to in a single phone call the day before surgery. The nurses set up a check-in system for the coats and valuables of patients and family members, which eliminated the need for every family to encamp with their belongings in a pre-op room for the entire day. A family-friendly waiting area was created, stocked with free snacks and drinks. There would be no more desperate searches for correct change. That was only the beginning. Patients had always resented having to purchase their post-op medications from the hospital pharmacy; simply freeing them to use their neighborhood drugstore got them out of the surgery line sooner, further relieving the congestion. Also in the interest of saving time, the nurses made a heretical proposal to allow healthy outpatients to walk into surgery under their own power, accompanied by their family members, rather than waiting 40 minutes for a wheelchair or gurney. That idea got the attention of the surgeons, who after years of paying ghastly malpractice premiums vowed that the administrator, not they, would suffer the personal liability on that one. The risk-management department went “eek” at the idea. Yet as the improvement committee pointed out, the hospital permitted outpatients to traverse any other distance in the building by foot. Why should the march into surgery be any different?In a similar vein, the nurses suggested allowing patients to wear underwear beneath their hospital gowns. The administrators could scarcely believe their ears: “Show me one place in the literature where patients wear underwear to surgery!” one top administrator demanded. (The nurses noted that restricting change to what had been attempted elsewhere would automatically eliminate the possibility of any breakthrough in performance.) And why stop at underwear, the nurses asked. The hospital was conducting more and more Chapter 8: Fostering a Culture of Collaboration and Teamwork141outpatient cataract operations; why not let these patients wear their clothes into surgery? “Contamination!” the purists cried. But clothing is no dirtier than the skin beneath it, the nurses answered. This change eliminated a major post-op bottleneck caused by elderly patients who could not dress themselves or tie their shoes with their heads clouded by anesthesia and their depth perception altered by the removal of their cataracts.As the changes took effect, the nurses observed another unintended effect. Patients were actually reducing their recovery times! People were no longer looking at ceiling tiles on their way into surgery like characters in an episode of Dr. Kildare. They went into surgery feeling better and came out of it feeling better. In case after case they were ready to leave the joint faster; this in turn freed up more space for other patients. Because they had studied practices at a number of stand-alone clinics, the nurses even suggested to the physicians that the outpatients would be better off with less anesthesia, hastening their recoveries, speeding their exit, and freeing up still more capacity.Within a year, the volume at the outpatient surgery unit had surged 50 percent with no increase in square footage and no increase in staff. Customer-service surveys were positive and costs were under control. And it dawned on the facilitator that the nurses’ intuitive conviction that the patient should come first benefited the surgery line itself at every single step. Everyone and everything connected to the process—surgeon, staff, insurers, time, cost, and quality—seemed to come out ahead when the patients’ interests came first.What was really happening, of course, was that the change teams simply put common sense first. In a complex process of many players, the interest of the patient was the one unifying characteristic—the best baseline for calibration—because the patient was the only person touched by every step. MLA (Modern Language Assoc.) Spath, Patrice, and Diane L. Kelly. Applying Quality Management in Healthcare?: A Systems Approach. Vol. Fourth edition, Health Administration Press, 2017. APA (American Psychological Assoc.) Spath, P., & Kelly, D. L. (2017). Applying Quality Management in Healthcare?: A Systems Approach: Vol. Fourth edition. Health Administration Press.